Thanks very much Shaba!
The first `one` was actually a typo by me! So thank you for your comment - which I thought was a bit harsh!
I always feel it is much better to try to find a positive way forward - as my piece (and also my recent BJGP editorial) undicates, these tools are far from perfect at assessing symptoms - but nor am I. The intelligent assessment of symptoms and signs is what I have been working on for years - and you might be interested in my book `Primary Care Diagnostics`. Machines can make mistakes and, after 31 years as a GP, I make lots of mistakes too.
Courage is also about using your own name to express views and opinions!!
Perhaps look at the New Years Honours lists Tony!
But I believe that those purchasing, procuring, designing or delivering health checks (including screening) are all looking for some sensible advice in order to do things differently and better.
Developing such recommendations would, undoubtedly, also be welcomed by those responsible for broader health care provision in appreciation of the potential impacts of ill-considered testing on hospitals.
However, at present, such guidance is largely absent and, although I have lobbied for action in the UK with NHS Screening and others, there seems little appetite to become involved.
I hope my recent book - recently reviewed in Pulse - might help to fill the gap.
Although I would not claim to have provided all the answers I have set out a new approach to health checks and screening based on value.
Hopefully this will need to more focused and evidence-based vitamin D testing too. Rather than the current chaotic situation!
This area does require careful consideration and I do worry about whether the current systems of NHS Screening are fit for purpose to undertake such a complex review compared to, for example, NICE.
There are certainly some inconsistencies between the USPSTF advice on colorectal cancer screening and age and their revised advice on prostate screening and age which needs looking into. In both cases the evidence for the benefits of screening at older ages is limited.
The PLCO and ERSPC trials included men 74 years and younger; men older than 70 years were not in the core age group (55-69 years) in the ERSPC trial. The CAP trial did not enrol men older than 69 years.
The USPSTF recommend that for men aged 55 to 69 years, the decision to undergo periodic prostate-specific antigen (PSA)–based screening for prostate cancer should be an individual one. I would suggest that this approach should continue be offered to those over the age of 70 with at least a 10-15 year life expectancy.
I visited the CQC earlier in the year to try to persuade them to shift their focus more towards measures of outcome than process. Moreover the University of Bristol had just published details of an excellent outcome tool for primary care. But I don`t think the CQC folk could really grasp what I was suggesting - but as none of them were in practice or GPs this should not have come as a surprise to me. Pity!
I think that it is very important that Prof Field`s successor is actually practising as a GP too - and will personally be subject to the CQC inspections.
Since joining the CQC as a specialist adviser it has concerned me how little importance the CQC seems to attach to its advisers (at all levels) continuing in practice.
Although this comment might lead to me being `terminated` as a CQC specialist adviser....so perhaps more time in practice for me!!
Currently there is a lot of interest – and hype – in using AI symptom checkers to reduce pressure on GPs such as myself.
But for those developing or using such AI symptom checkers I would encourage them to consider four important issues:
1. Have the symptoms (or symptom combinations) being considered by the AI symptom checker been carefully selected? Are they clearly defined? Are they reliable? Are they clinically sensible?
2. Has careful thought been given to the types of individuals who might use the AI symptom checker? And does the tool have any limitations by age, gender, health care setting or geographical location?
3. Has the AI symptom checker been assessed for safety and effectiveness in the real world with real people? Or has it just undergone artificial evaluation using statistics or standardised stories?
4. Has due consideration been given to the impact of the AI symptom checker on classical (e.g. reducing death & disability), patient-oriented (e.g. enhancing empathy, trust and understanding) and economic outcomes?
Dr Nick Summerton
I stopped working as an appraiser as I felt that my role was become more `regulatory` rather than `supportive`. My other concern was that many elements of the current system might encourage some doctors to become `creative` in their audits, significant events and CPD. Also the 360 has become more about `if you scratch my back I`ll scratch yours`. What really concerns me is that revalidation might simply be making some trustworthy doctors less trustworthy. We really need a fresh approach. Dr Nick Summerton
This is a very fair article about private health screening - albeit with no mention about the `NHS Health Checks Programme`! I hope my forthcoming book 'Better Value Health Checks' will serve as a useful practical guide to those designing and delivering health checks (private and public). Value is about considering what we are trying to achieve (outcomes) and at what cost. Costs are not simply about the price of the health check but also the costs to the NHS, private health insurers, individuals and organisations.
As both an NHS GP and Medical Director for a private screening company I am keen to address the points made in this piece in addition to those of my GP colleagues. My next book 'Better Value Health Checks' is due out later this year and I hope this will serve as a useful guide to all those seeking to design and deliver health checks (private and public)
Thanks very much for all the comments. But I remain unrepentant. Striking is not something that professionals should do - I might be old, conservative, conflicted and have an interest in Ancient Medicine but I do care about my patients and my profession still. I am also reasonably well trained and qualified! The one point I do take exception to is, however, the very idea that I have a cardigan! Nick